Abstract Serotonergic psychedelics reliably alter affective tone, emotional regulation, and self-experience. Prevailing theories emphasize acute changes in neural entropy, default mode network integrity, and large-scale functional connectivity but do not offer a clear mechanism that explains how 5-HT2A receptor pharmacology relates to lasting changes in affect and self-related processing. This article addresses this gap by proposing a testable mechanistic framework in which serotonergic modulation of excitation–inhibition (E-I) balance functions across a hierarchical regulatory architecture of the Affective Core Self, linking molecular, circuit, and network processes to shifts in affective self-dynamics. This theoretical article integrates evidence from neuroimaging and psychopharmacological studies of serotonergic psychedelics to evaluate this proposed mechanism that connects affective neurobiology with changes in self-related processing. Evidence is organized within a hierarchical Affective Core Self framework that includes homeostatic–autonomic, limbic, salience-network, and cortical self-referential regulatory levels. In this model, 5-HT2A receptor activation is proposed to influence E-I dynamics that may propagate across neural circuits and large-scale networks through vertical coupling among Affective Core Self levels. These vertically coupled interactions provide mechanisms through which psychedelic neuromodulation may reorganize affective tone and self-experience within this four-level Affective Core Self regulatory system. Post-acute plasticity and inhibitory recalibration are proposed to stabilize some of these altered regulatory dynamics. This provides a novel model linking acute psychedelic perturbation to enduring changes in affective regulation and self-experience and illustrates how psychedelic neuromodulation can reorganize the affective core of self-processing. This proposal generates falsifiable predictions that can be evaluated through measures of cortical E-I balance, bottom-up effective connectivity dynamics, and autonomic and affective regulation to assess whether psychedelic perturbations propagate across the levels of the Affective Core Self and are correlated with therapeutic outcomes.
Abstract Background and aims As contributions to this special issue attest, psychedelic integration is currently garnering much scholarly attention. However, given that most agree the focus on integration is recent, this paper asks why integration is being given such an emphasis now. What has changed in Western cultures of psychedelicisms, once preoccupied with just ‘set and setting’, that necessitates such concern with what comes after the dose? Methods A discourse analysis of recent definitions of the term ‘integration’ was undertaken, and the results read through the lens of ‘margalogy’. Margalogy examines the ways, cross-culturally, that techniques of some desired transformation are canalised, formalised, and institutionalised into a ‘path’. Results Discourse analysis reveals two anxieties implicit within ‘integration’, both driven, in the so-called psychedelic renaissance, by the medicalisation of psychedelics. The first and ostensible anxiety concerns the need for psychic integration, but the second, implicit anxiety is concerned with integrating clients back into society without the upset that characterised the 1960s: societal integration. Conclusions The tripartite schema of preparation, dose, integration found in psychedelic-assisted therapy (PAT) is usefully read as a path , one necessitated by medicalisation. PAT as path is scaffolded with intentional elements, which include preparation and the much-emphasised integration, that are put in place to mitigate the risks of the non-intentional elements that arise from the capricious nature of psychedelics themselves. Examples drawn from psychedelicisms that predate the so-called renaissance suggest that faith in the ability of the integrative path to bring that caprice to heel may not be justified.
Abstract The aim of this position paper is to explore and discuss the intersection of music therapy and psychedelic-assisted therapy, focusing on the safe and effective use of music during psilocybin treatment. Key points include a historical overview of psychedelic therapy, an examination of current research on the use of music in psychedelic therapy, and a rationale for why an advanced-trained music therapist is best suited for providing receptive music experiences during psychedelic therapy. The goals are to bring awareness of the importance of music selection to the therapeutic process and to frame a recommendation of utilizing music therapists as the experts in facilitating music experiences while working in psychedelic therapy settings, ensuring safe, ethical, and supportive musical experiences for participants.
Abstract Recent discussions of psychedelic-assisted psychotherapy (PAP) have raised concerns about its potential to produce unpredictable and persistent personal transformations that patients cannot fully anticipate and may subsequently regret. These concerns pose challenges for informed consent and have contributed to arguments for psychedelic ethical exceptionalism. In this conceptual commentary, we propose a process-based, agency-sensitive account of personal transformation. Rather than treating psychedelic transformation as a ‘single’ event imposed upon a ‘passive’ subject, we distinguish between a potentially rapid transformative trigger, the subsequent process throughout which psychedelic experiences are interpreted and integrated, and its longitudinal outcomes. Patients' agency may vary across these phases, being particularly compromised during acute psychedelic experiences while playing a greater role during preparation, integration, and longer-term reflection. This account does not eliminate the informed-consent challenges associated with PAP, including the possibility of persistent and regretted personal change, but suggests that they do not by themselves require a fundamentally exceptional framework for informed consent. We argue instead for enhanced disclosure of transformative uncertainty, attention to patients' susceptibility during acute and interpretative phases, and follow-up practices that support patients' agency in responding to persistent personal changes.
